Many countries such as The Republic of Korea have established their own nutritional standards, collectively termed Nutrient Reference Values(NRVs), and they vary due to the science which was reviewed, the purposes for which they are developed, and issues related to nutrition and food policy in the country. The current effort by the Codex Alimentarius Committee on Nutrition and Foods for Special Dietary Uses (CNFSDU) to update the NRVs that were established following the Helsinki Consultation in 1988 represents an opportunity to develop a set of reference values reflecting current scientific information to be used or adapted by many countries. This paper will focus on possible approaches to selecting or developing reference values which would serve the intended purpose for nutrition labeling to the greatest extent possible. Within the United States, the Food and Drug Administration (U.S. FDA) is currently reviewing regulations on nutrition labeling to better address current health issues, and is expected to enter into a process in the next few months to begin to explore how best to update nutrient Daily Values (DVs), most of which are still based on the Recommended Dietary Allowances (RDAs) of the Food and Nutrition Board, U.S. National Academy of Sciences, last reviewed and revised in 1968. In this presentation, I review the current purposes in the U.S. for nutrition labeling as identified in the 1938 Food, Drug, and Cosmetic Act as amended, the scientific basis for current nutrition labeling regulations in the United States, and the recommendations made by the recent Committee on Use of Dietary Reference Intakes in Nutrition Labeling of the Institute of Medicine (2003) regarding how to use the DRIs in developing new DVs to be used on the label in the United States and Canada. Based on these reviews, I then provide examples of the issues that arise in comparing one approach to another. Much of the discussion focuses on the appropriate role of nutrient labeling within the Nutrition Facts panel, one of the three major public nutrition education tools in the United States (along with MyPyramid and Dietary Guidelines for Americans).
Canada ; Education ; Food Labeling* ; Institute of Medicine (U.S.) ; National Academy of Sciences (U.S.) ; Nutrition Policy ; Recommended Dietary Allowances ; Reference Values* ; Republic of Korea ; Social Control, Formal ; United States ; United States Food and Drug Administration

As people age, structural as well as neural degeneration occurs throughout the auditory system. Many older adults experience difficulty in understanding speech especially in adverse listening conditions although they can hear speech sounds. According to a report of the Committee on Hearing and Bioacoustics and Biomechanics of the National Research Council, peripheral, central-auditory, and cognitive systems have long been considered major factors affecting the understanding of speech. The present study aims to review 1) age-related changes in the peripheral, central-auditory, and cognitive systems, 2) the resulting decline in the understanding of speech, and 3) the clinical implication for audiologic rehabilitation of older adults. Once the factors affecting the understanding of speech in older adults are identified and the characteristics of age-related speech understanding difficulties are examined, clinical management could be developed for prevention and treatment. Future research about problems related to the understanding of speech in older adults will help to improve the quality of life in the elderly.
Adult ; Aged ; Aging* ; Cognition ; Correction of Hearing Impairment ; Hearing ; Humans ; National Academy of Sciences (U.S.) ; Phonetics ; Quality of Life

Despite the successful development of modern medical educational systems within the last century, such systems need improvement in terms of developing better ways to educate medical students as future clinicians while also nurturing them to be good physician scientists. The period from 1964 to 1972 was called the Golden Era of Nobel Laureates in Medicine. Nine laureates, all graduates from American medical schools, came to the United States National Institute of Health (NIH). During the Vietnam War, many medical doctors substituted military service for service in the NIH, became members of the United States National Academy of Sciences, and attained brilliant medical and scientific achievements. There is a crucial lesson to learn from this golden time of the NIH: ambitious young physicians given opportunities to become cutting-edge scientists can make fundamental discoveries. In hopes of encouraging a similar “golden era” for medical research in Korea, I suggest three steps. First, medical schools and the educational system should provide medical students with more opportunities to conduct in-depth medical research in various fields. Second, the Physician Scientist Program should be further expanded to include more medical students and clinical board holders. Better treatments and approaches are essential for gathering both bright candidates and brilliant mentors, who will support each other in making outstanding scientific discoveries. Finally, the flexibility of the medical educational system in terms of medical students and clinical residency needs updating. In conclusion, a national medical educational system that is well balanced can maintain and support both excellent physician scientists and skillful clinicians.
Hope ; Humans ; Internship and Residency ; Korea ; Mentors ; Military Personnel ; National Academy of Sciences (U.S.) ; Pliability ; Schools, Medical ; Students, Medical ; United States ; Vietnam

Since halothane, as a new potent, non-explosive, volatile agent, was introduced by Raventos(1956) and studied clinically by Johnstone(1958), Bryce-Smith (1958) and Stephen(1958), it has been used extensively all over the world. However recent case reports of liver necrosis following halothane anesthesia have raised the possibility that the agent may, under certain circumstance, damage the liver. Following the announcement of cooperative study of effects of halothane on the liver by the National Research Council Committee on anesthesia of U.S.A. in 1963, this investigation was undertaken. Experiments were carried out in 31 anesthetixed mongrel dogs, weighing approximately 10kg. After anesthesia with pentothel sodium (25mg/kg), an endotracheal tube with cuff was passed and connected to a closed circle absorption system using an Ohio Heidbrink machine. Oxygen flow was 300 to 500 ml/min. Fluotec Mark II vaporizer, using 1.5 to 2% for induction and 0.5 to 1% for maintenance, was set up outside of the circle system. Depth of anesthesia was judged mainly by clinical signs eg. respiration and blood pressure, and halothane anesthesia lasted for 3 hours. After laparotomy, a ligation of the cystic duct was done and bile was collected from the cannulated common bile duct continuously. Studies have been made on the cardiac output and hepatic blood flow with changes of blood pressure, bile formation, function of dye excretion, changes of serum protein, prothrombin time, coagulation time and histopathological changes of the liver. The results obtained may be summarixed as follows. 1. Measuring of cardiac output using RIHSA after halothane administration with lowered blood pressure, as compared with investigations before halothane (average blood pressure 155mmHg),showed 12.4% decrease in light anesthesia (average B.P. 140mmHg) and 27% in deep anesthesia (average B.P. 70mmHg). 2. Hepatic blood flow measured with radioactive colloidal gold(Au198) showed 218 ml/min in the control group (B.P. 170mmHg) and 309 ml/min in the deep halothane anesthesia group (B.P. 80mmHg). Thus there was a 42% increase in deep halothane anesthesia. As the blood pressure decreased the cardiac output also decreased but the hepatic blood flow showed a tendency to increase. 3. The amount of bile flow and cholate output in the pre-halothane state was 0.040 ml/min and 1. 069 mg/min, respectively. After halothane administration, the bile was significantly increased to 0. 061 ml/min at 90 min. Thereafter it returned to the initial level 3 hours later and cholateoutput continuously decreased for 3 hrs., showing that halothane may have a hydrocholeretic effect. Before and after the halothane administration, pO2 in arteral blood was 344 and 377 mmHg, pCO2 in arterial blood was 38.5 and 40.9mmHg, respectively. The pO2, pCO2, pH and electrolytes (sodium, potassium and chloride concentration) in the hepatic bile did not reveal a significant change. Electrolytes (sodium, potassium and chloride), and osmolarity in urine did not show significant changes.4. The function of biliary dye excretion was studied using bromsulfalein (BSP), phenol red (PSP) and indocyanine green. The one hour biliary excretion of indocyanine green did not show significant changes between the control group, the group with exposure only, and the group with two exposures with an interval of 1 week. However, the biliary excretion of indocyanine green for 2 hours was 45% of the given amount for the control group, 41% for one exposure, and 37% for the group with two exposures. PSP biliary clearance, before and after haIothane administration, showed 19.62 ml/min and 13. 35 ml/min respectively, but BSP biliary clearances were 21. 3 ml/min and 22. 0 ml/min respectively. It is concluded that the biliary excretion of indocyanine green and PSP showed a tendency for a decrease following halothane administration. 5. The coagulation time and prothrombin time, measured after halothane administration, were shortened during the first hour, and after this, they were gradually prolonged, returning to normal m two to three hours after the administration. The values of serum protein and thymol turbidity did not show significant differences among each group and between the time before and after halothane administration. 6. The histopathological examination showed that the anesthetic group had a much more intense degree of degenerative changes of liver parenchymal cells including vacuolar formation and hydropic degeneration, in addition to vasodilatetion, compared with the biopsy before halothane. 7. The above studies indicate that halothane administration exerts a slight influence on the hepatic function and induces histological changes in the liver. However, quantitative comparison between halothane and other anesthetic drugs will be clarified by further studies.
Absorption ; Anesthesia ; Anesthetics ; Animals ; Bile ; Biopsy ; Blood Pressure ; Cardiac Output ; Cholates ; Colloids ; Common Bile Duct ; Cystic Duct ; Dogs* ; Electrolytes ; Halothane* ; Hydrogen-Ion Concentration ; Indocyanine Green ; Laparotomy ; Ligation ; Liver ; National Academy of Sciences (U.S.) ; Nebulizers and Vaporizers ; Necrosis ; Ohio ; Osmolar Concentration ; Oxygen ; Phenolsulfonphthalein ; Potassium ; Prothrombin Time ; Respiration ; Sodium ; Thymol

Even though suicide ranks as the fourth cause of death and is causing a significant loss in Korea, it seems that the conventional notion regarding suicide as a feasible way of solving a troublesome life situation hinders early recognition and proper management of suicide. This article reviews suicide prevention strategies recommended based on robust experience and scientific understanding of the characteristics of the suicide problem. In the UK, a suicide prevention strategy was formed at the national level suggesting significant goals to reduce the rate of suicide. In the US, the Institute of Medicine study committee examined the state of the science base, gaps in knowledge, strategies for prevention, and research designs for the study of suicide. This recommendation includes more science-based, coherent and well-coordinated multidisciplinary approaches, and thus suggests important practical recommendations for a suicide prevention strategy of Korea. The author concludes that suicide should be defined as a treatable and even preventable medical condition. Constructing a national network of suicide research, data surveillance, developing tools for suicide prevention including early detection and safety planning, and comprehensive insurance coverage are recommended.
Cause of Death ; Depression ; Institute of Medicine (U.S.) ; Insurance Coverage ; Korea ; Research Design ; Suicide

The purpose of this study was to investigate weight gain during pregnancy based on pre-pregnant Body Mass Index, to compare eating habits based on the recommended standards for weight gain presented by the Institute of Medicine, and to identify factors affecting the weight gain of pregnant women. The subjects were grouped into three categories according to the recommended weight gain standards presented by the Institute of Medicine: the inadequate group, the adequate group and the excessive group. The excessive group had a significantly higher pre-pregnant Body Mass Index than that of the two other groups. Based on a comparison of the eating habits and nutrient intake of the women to the recommended standards for weight gain, the excessive gain group had large meals and ate more frequently outside of the home when compared to the pre-pregnancy period. Based on an analysis of correlations between weight gain during pregnancy and diet factors, the adequate gain group had positive correlation between weight gain and a "balanced meal" and had negative correlation with "convenience meals". The excessive gain group had a positive correlation with "convenience meals" and had a negative correlation with "meal skipping." All the pregnant women were more frequent in the "overeating categories" and all ate more "fruit," as their weight gain was higher. In particular, the excessive gain group was frequently evaluated as "overeating". These results indicate that the factors affecting weight gain during pregnancy were the Body Mass Index before pregnancy, eating types, and eating habits. As the Body Mass Index before pregnancy was higher, the ingestion of a 'balanced meal' was less, and overeating and gluttony were more frequent. Therefore weight gain was enhanced.
Body Mass Index ; Diet ; Eating ; Female ; Humans ; Hyperphagia ; Institute of Medicine (U.S.) ; Meals ; Pregnancy ; Pregnant Women ; Weight Gain

Improving mental health and reducing the burden of mental illness are complementary strategies which, along with the treatment and rehabilitation of people with mental disorders, significantly improve population health and well-being. A Institute of Medicine report describes a range of interventions for mental disorders that included treatment and maintenance, reserving the term "prevention" for efforts that occur before onset of a diagnosable disorder. Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability and their long lasting consequences, the mental health needs of children and adolescents are neglected. Early intervention can help reduce the significant impacts that children and adolescents with serious mental health problems may experience. Screening is the first step in early intervention, recognizing emotional and behavioral problems and providing help at an early stage. It is essential to implement early intervention in a sensitive and ethical manner to avoid any of the negative outcomes.
Adolescent* ; Child* ; Early Intervention (Education) ; Humans ; Institute of Medicine (U.S.) ; Mass Screening ; Mental Disorders ; Mental Health* ; Primary Prevention ; Rehabilitation ; Resin Cements

PURPOSE: To compare parameters of confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] II) in high myopia with age- and sex-matched emmetropes. METHODS: A hospital-based cross-sectional study was conducted among Nepalese subjects aged 18 to 35 years at BP Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Maharajgunj, Kathmandu from November 2015 to October 2016. Fifty consecutive subjects with high myopia (spherical equivalent ranging from −6.00 to −12.00 diopters) and age- and sex-matched emmetropic subjects were enrolled for comparison. Correlations between disc area and other HRT parameters, asymmetry between the right and left eyes, and comparisons between male and female subjects in both high myopic and emmetropic groups were evaluated. RESULTS: Disc area was not significantly (p = 0.11) larger in high myopic eyes than in emmetropic eyes. HRT parameters in highly myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes. Disc area was found to be significantly positively correlated with inter disc parameters and significantly negatively correlated with rim to disc area ratio in the high myopia group. Disc area and other intra-disc parameters showed significant correlations between right and left eyes in both high myopia and emmetropia, and no significant differences between males and females from a Nepalese population. CONCLUSIONS: Characteristics of HRT parameters in high myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes in a Nepalese population. The effect of disc area on HRT parameters differed significantly only in height variation contour by emmetropic eyes.
Cross-Sectional Studies ; Emmetropia ; Female ; Humans ; Institute of Medicine (U.S.) ; Lions ; Male ; Myopia ; Ophthalmoscopy ; Optic Disk ; Optic Nerve ; Retinaldehyde

OBJECTIVE: Pre-pregnancy weight and excess weight gain during pregnancy were associated with obstetric outcomes and plasma leptin was reported to have association with postpartum weight retention. The purpose of this study was to examine the relationships between pregnancy related factors including plasma leptin and weight gain during pregnancy and postpartum weight retention. METHODS: Seventy-five women were observed through pregnancy and 6 months postpartum. First trimester, third trimester and postpartum leptin were measured by radioimmunoassay. Weight gain categories were based on the Institute of Medicine recommendations. Relationships between pregnancy related factors and leptin were examined. And relationship between leptin and postpartum weight retention was also examined. RESULTS: Among subjects, 44.0% of women had concerns for postpartum weight retention and 18.9% had diet controls for postpartum weight management. Initial BMI categories by IOM classification were underweight, 29 (38.7%), normal, 37 (49.3%), and overweight group, 9 (12.0%). Underweight group was largely below IOM weight gain recommendation and overweight group was largely over IOM weight gain recommendation (P=0.013). First trimester leptin was correlated with pregravid BMI (r=0.678, P=0.000), maternal weight at term (r=0.547, P=0.006) and postpartum BMI (r=0.608, P=0.002), but not correlated with weight gain during pregnancy and postpartum weight retention. Third trimester leptin was not correlated with above variables. Initial BMI categories by IOM were significantly correlated with first trimester leptin, leptin at 5 weeks postpartum, maternal weight at term (0.741, P=0.000), weight at 5 weeks postpartum (r=0.728, P=0.001) and weight at 6 months postpartum (r=0.684, P=0.002). CONCLUSION: These results suggest that first trimester plasma leptin may predict maternal weight at term and initial BMI categories may be a predictor of maternal weight at 5 weeks postpartum and 6 months postpartum. However, weight gain during pregnancy was not correlated with postpartum weight retention.
Classification ; Diet ; Female ; Humans ; Institute of Medicine (U.S.) ; Leptin ; Overweight ; Plasma ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Third ; Radioimmunoassay ; Thinness ; Weight Gain

OBJECTIVES: To evaluate the mobile health applications (apps) developed by a single tertiary hospital in Korea with a particular focus on quality and patient safety. METHODS: Twenty-three mobile health apps developed by Asan Medical Center were selected for analysis after exclusion of the apps without any relationship with healthcare or clinical workflow, the apps for individual usage, and the mobile Web apps. Two clinical informaticians independently evaluated the apps with respect to the six aims for quality improvement suggested by the United States Institute of Medicine. All discrepancies were resolved after discussion by the two reviewers. The six aims observed in the apps were reviewed and compared by target users. RESULTS: Eleven apps targeted patients, the other 12 were designed for healthcare providers. Among the apps for patients, one app also had functions for healthcare providers. 'My cancer diary' and 'My chart in my hand' apps matched all the six aims. Of the six aims, Timeliness was the most frequently observed (20 apps), and Equity was the least observed (6 apps). Timeliness (10/11 vs. 10/12) and Patient safety (10/11 vs. 9/12) were frequently observed in both groups. In the apps for patients, Patient-centeredness (10/11 vs. 2/12) and Equity (6/11 vs. 0/12) were more frequent but Efficiency (5/11 vs. 10/12) was less frequent. CONCLUSIONS: Most of the six aims were observed in the apps, but the extent of coverage varied. Further studies, evaluating the extent to which they improve quality are needed.
Chungcheongnam-do ; Delivery of Health Care ; Health Personnel ; Humans ; Institute of Medicine (U.S.) ; Korea ; Patient Safety ; Patient-Centered Care ; Quality Improvement* ; Telemedicine* ; Tertiary Care Centers* ; United States